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中国防痨杂志 ›› 2010, Vol. 32 ›› Issue (3): 123-128.

• 论著 • 上一篇    下一篇

我国二线抗结核药物使用现状调查研究

胡远莲, 何广学, 刘志敏, 郑建礼, 邢超   

  1. 中国疾病预防控制中心结核病预防控制中心； 山东省结核病防治中心； 山东省胸科医院； 第七轮中国全球基金结核病项目办；
  • 出版日期:2010-03-20 发布日期:2010-03-20
  • 基金资助:

    第5轮中国全球基金结核病项目

A study on the usage of second-line anti-tuberculosis drugs in China

Hu Yuanlian，He Guangxue，Liu Zhimin，Zheng Jianli，Xing Chao   

  1. 1.National Center for TB control and prevention,China Center for Disease Control and Prevention,Beijing 102206,China;2.Center for TB control and prevention of Shandong/Chest hospital of Shandong province,Jinan 250013,China;3.China Global Fund Round Seven TB Program,Beijing 102206,China
  • Online:2010-03-20 Published:2010-03-20
  • Contact: He Guangxue E-mail:heguangxue@chinatb.org

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摘要： 目的 调查各级结防机构、结核病专科医院和综合医院二线抗结核药物（second-line anti-tuberculosis drugs, SLD）的使用情况，为国家进一步制定合理使用SLD的相关政策提供资料。 方法 采用分层目的 抽样，按照我国东、中、西的地理位置分布，东、中、西部各抽取4个省，共抽取12个省，各省所有地市和县都参与调查。对各级结核病防治机构、结核病专科医院、综合医院和乡镇卫生院（以下总称为“医疗、结防机构”）进行问卷调查，并将调查问卷进行汇总分析。 结果调查4-782个机构，72.6%的机构使用了SLD。省市县乡各级医疗、结防机构，使用SLD的比例依次降低，分别为：省级87.0%，地市级83.4%，县区级72.0%，乡镇级70.3%。不同类型的机构使用SLD的比例也不相同，结核病防治所设在结核、胸、肺科医院以及定点医院（98.7%）、结核病医院和有结核病科的专科病院（100%）、综合医院（99.4%）较高。疾病预防控制中心（简称“CDC”）内设结核病防治所（科）较低（22.9%）。不同的SLD使用的比例也不相同，丁胺卡那霉素（49.6%）、氧氟沙星（42.3%）、 左氧氟沙星（66.2%）和 环丙沙星（39.5%）使用的比例较高。仅有92家（1.9%）医疗、结防机构做一线抗结核药物的药物敏感性试验。影响SLD使用的因素有：地区、机构类型、是否有结核病门诊和病房、结核病床位数、是否做痰涂片、是否做痰培养（P均<0.001）和患者涂阳率（P<0.05）等。药物敏感性试验不是使用SLD的影响因素（P=0.771）。 结论 SLD在各级结防、医疗机构使用很普遍，不同级别、不同类型的机构以及不同SLD的使用存在较大差异，而药物敏感性试验很少开展。国家应制定有关合理使用SLD的政策，促进SLD药物敏感性试验的开展。

关键词: 抗生素类, 抗结核, 荧光喹诺酮类;丁胺卡那霉素, 卷曲霉素硫酸盐

Abstract: Objective To investigate the usage of second-line anti-tuberculosis drugs (SLD) in medical institutions at all levels, and provide scientific evidence for policy development in China.  Method A stratified purposive sampling method were adopted, and a total of 12 provinces were involved in the cross sectional survey. Questionnaires were performed to all TB prevention and control institutions, tuberculosis specialist hospitals, general hospitals and rural health clinics at each level.  Results A total of 4782 institutions were involved in the survey, and 72.6% of them have used SLD. The proportion of institutions using SLD decreased by level, as follows: 87.0% for provincial level, prefecture and city level 83.4%, district level 72.0%, township level 70.3%.The proportion of SLD use varied between different type of institutions, with 98.7% of TB institutions which were based in tuberculosis, chest, pulmonary hospital, as well as designated hospitals, 100% of TB special hospital, 99.4% of general hospital. However, only 22.9% of TB institutions which are based in CDC used SLD. For the usage of different kind of SLD, there were great variations in terms of proportion of institutions using. Among them, Amikacin(49.6%), Ofloxacin(42.3%), Levofloxacin(66.2%), Ciprofloxacin(39.5%) had a higher proportion. Only 92 （1.9%）institutions perform drug susceptibility testing (DST) for first-line TB drug. Factors affecting the use of SLD are: region, type of institution, whether there are TB clinics and wards, number of beds for tuberculosis patients, whether perform sputum smear, whether perform sputum culture (P all<0.001) and patients smear-positive rate (P<0.05) etc. Drug susceptibility testing is not the influencing factors for SLD use (P=0.771). Conclusion SLD is commonly used in China. The use of SLD varied between different level, different kind, and different type of institutions. DST is seldom performed. Therefore China should develop a policy on the rational use of SLD, and promote DST for SLD.

Key words: antibiotics, antitubercular, fluoroquinolines, amikacin, capreomycin sulfate

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